Perception of faces in schizophrenia: Subjective (self-report) vs. objective (psychophysics) assessments

https://doi.org/10.1016/j.jpsychires.2016.02.012Get rights and content

Abstract

Objectives

Face perception impairment in schizophrenia has been demonstrated, mostly through experimental studies. How this laboratory-defined behavioral impairment is associated with patients’ perceptual experience of various faces in everyday life is however unclear. This question is important because a first-person account of face perception has direct consequences on social functioning of patients. In this study, we adapted and administered a self-reported questionnaire on narrative perceptual experience of faces along with psychophysical assessments of face perception in schizophrenia.

Methods

The self-reported questionnaire includes six rating items of face-related functioning in everyday life, providing a subjective measure of face perception. The psychophysical assessment determines perceptual threshold for discriminating different facial identities, providing an objective measure of face perception.

Results

Compared to controls (n = 25), patients (n = 35) showed significantly lower scores (worse performance) in the subjective assessment and significantly higher thresholds (worse performance) in the objective assessment. The subjective and objective face perception assessments were moderately correlated in controls but not in patients. The subjective face perception assessments were significantly correlated with measurements of a social cognitive ability (Theory of Mind), again in controls but not in patients.

Conclusion

These results suggest that in schizophrenia the quality of face-related functioning in everyday life is degraded and the role that basic face discrimination capacity plays in face-related everyday functioning is disrupted.

Section snippets

Objectives

Schizophrenia patients have severe social functioning problems in everyday life (Green et al., 2008, Harvey, 2013). Given that human faces provide a rich source of social information, understanding social functioning problems in this psychiatric disorder should begin with and focus on face processing. In fact, face perception impairments have been shown in schizophrenia (Phillips and David, 1995, Chen, 2011, Darke et al., 2014, Bortolon et al., 2015). The impaired perception of faces was

Participants

Thirty-five schizophrenia patients (SZ) participated. All patients met DSM-IV criteria for schizophrenia or schizoaffective disorder, based on a standardized interview (First et al., 1994) and a review of all available clinical records. All patients were outpatients when participating in this study with an average illness duration of 20.36 years (std: 13.01 years). All but four patients were medicated with antipsychotic drugs (averaged CPZ dose equivalent = 387.9 mg (std: 359.0 mg)) (Woods, 2003

Face perception questionnaire (subjective)

Table 2 presents average ratings for each item of the face perception questionnaire as well composite scores. The composite scores differed significantly between the two participant groups (t = 3.57, p < 0.001), indicating degraded quality of everyday face-related experience in the patient group. For the ratings of individual items, the two groups were significantly different in item 1 (t = 2.71, p < 0.01), item 2 (t = 2.27, p < 0.05) and item 5 (t = 2.43, p < 0.05), but not in other items.

Psychophysical measurements (objective)

Discussion

Face perception in schizophrenia patients was degraded, as evaluated by both the subjective and the objective assessments. Unlike in healthy controls, face-related everyday experience in schizophrenia patients is neither associated with the basic perceptual capacity to discriminate facial identities, nor with the social cognitive ability to ascribe a correct emotion state to others (Theory of Mind).

Contributions

The manuscript presents original material and has not been considered for publication elsewhere. Both authors have made substantial contributions to this work. Yue Chen designed the study and prepared the manuscript. Tor Ekstrom performed the surveys, the psychological tests and data analysis, and revised the manuscript. Both authors had full access to the data and approved this manuscript for submission.

Role of funding source

This work was supported in part by a grant from NIH (MH R01 096793).

Acknowledgment

The authors thank Dr. Ongur for supervision of clinical evaluation, Dr. Maher for discussion of Capgras delusion, and Ms. Salcone for comments on the paper.

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